Y7//: GO\UCOCCUS OR MICROCOCCUS GOXu/tKIHEJB 371 



both Loeffler's methylene-blue solution and by (Aram's method, and 

 the examination repeated on three consecutive days. Should these 

 specimens prove negative, to exclude any possible doubt in the matter, 

 cultures should then be made on human ascitic fluid or serum agar, 

 poured in dishes; also, if with negative results, on three consecutive 

 days. Heiman, who has paid much attention to gonococcus examina- 

 tions, obtains his material by the following method: in chronic urethritis 

 he allows the patient to void his urine either immediately into two 

 sterilized centrifugal tubes or first into two sterile bottles. The first 

 tul>e will contain threads of the anterior urethra; the second tube will 

 be likely to contain secretion from the posterior urethra and from the 

 prostate gland if, while urinating, the patient's prostate l>e pressed 

 upon with the finger. Tubes containing such urine are placed in the 

 centrifuge and whirled for three minutes at twelve hundred or more 

 revolutions per minute; the threads are thrown down. The centrifuged 

 sediment will be found to contain most of the bacteria present, epithelial 

 cells, and, at times, spermatozoa. Normal urine on being centrifuged 

 at this velocity will be found at times to show a slight turbidity at the 

 bottom of the tube. This will be found, on microscopic examination, 

 to consist of epithelial cells, a few leukocytes, and some bacteria. 



The careful examination of gonorrhceal threads stained by Gram's 

 method is a very tedious affair, as in every instance no less than three 

 cover-glass preparations should be looked over before the absence of 

 the gonococcus is considered probable. It would require many hours 

 upon each and every specimen, especially if the gonococci are present 

 in very small number, before a reliable and conscientious opinion 

 could be rendered. If, after all, a negative opinion is ventured, we 

 still are under the necessity of proving that because the threads which 

 we fished out for the cover-glass examination were free from gonococci 

 the remaining ones were also. For this reason the culture medium 

 is more sensitive for bacteria than is the cover-glass, for we are able 

 to plant each and every thread of the sediment in the centrifugal tube. 

 Results on culture media are only reliable when obtained by thor- 

 oughly trained bacteriologists with suitable media and methods. Fiir- 

 bringer, in his work, mentions the fact that in certain cases the absence 

 of the gonococcus in many examinations of cover-glass preparations 

 is not a positive proof that 'the gonococcus is not present. The culture 

 methods, of course, presuppose that one has the facilities and knowl- 

 edge to carry them out successfully, otherwise the microscopic methods 

 are to be used alone. 



In acute cases where the pus is abundant the specimen for examina- 

 tion may be collected, when the patient is before one, by passing a 

 sterilized platinum-wire loop as far up into the urethra as possible and 

 withdrawing some of the secretion. 



Occurrence in Cultures from Chronic Urethritis. Heiman in 61 cases 

 found the gonococcus in 14 by cultures and in !'> by smears. The 

 following results were obtained by other observers by cover-glass prep- 

 arations: Goll, according to his elaborate article, examined 1046 cases 



